title: Sleep, physical activity and BMI in six to ten-year-old children measured by accelerometry: a cross-sectional study.
abstract: BACKGROUND
  The aim of this study is to describe the relationship between objective measures of sleep, physical activity and BMI in Swedish pre-adolescents. The day-to-day association between physical activity and sleep quality as well as week-day and weekend pattern of sleep is also described.
  
  
  METHODS
  We conducted a cross sectional study consisted of a cohort of 1.231 children aged six to ten years within the Stockholm county area. Sleep and physical activity were measured by accelerometry during seven consecutive days. Outcome measures are total sleep time, sleep efficiency, sleep start and sleep end; physical activity intensity divided into: sedentary (<1.5 METS), light (1.5 to 3 METS) and moderate-to-vigorous (> 3 METS); and Body Mass Index standard deviations score, BMIsds.
  
  
  RESULTS
  Total sleep time decreased with increasing age, and was shorter in boys than girls on both weekdays and weekends. Late bedtime but consistent wake-up time during weekends made total sleep time shorter on weekends than on weekdays. Day-to-day within-subject analysis revealed that moderate-to-vigorous intense physical activity promoted an increased sleep efficiency the following night (CI < 0.001 to 0.047), while total sleep time was not affected (CI -0.003 to 0.043). Neither sleep duration (CI -0.024 to 0.022) nor sleep efficiency (CI -0.019 to 0.028) affected mean physical activity level the subsequent day. The between-subject analysis indicates that the sleep of children characterized by high moderate-to-vigorous physical activity during the day was frequently interrupted (SE = -.23, P < .01). A negative association between BMIsds and sleep duration was found (-.10, p < .01).
  
  
  CONCLUSIONS
  Short sleep duration was associated with high BMI in six to ten year old children. This study underscores the importance of consistent bedtimes throughout the week for promoting sleep duration in preadolescents. Furthermore, this study suggests that a large proportion of intensive physical activity during the day might promote good sleep quality.
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden. Mirjam.ekstedt@sth.kth.se
authors.forename: Mirjam
authors.initials: M
authors.lastname: Ekstedt
authors.forename: Gisela
authors.initials: G
authors.lastname: Nyberg
authors.forename: Michael
authors.initials: M
authors.lastname: Ingre
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Ekblom
authors.forename: Claude
authors.initials: C
authors.lastname: Marcus
mesh_terms: D061725:Accelerometry / Q000379:methods; D000367:Age Factors; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications; D057185:Sedentary Behavior; D012737:Sex Factors; D012890:Sleep; D013548:Sweden; D014851:Wakefulness